Specialized Roentgen Diagnostic Technics in the Investigation of Abdominal Disease

Diseases involving the abdominal organs have been the subject of radiologic investigation almost since the discovery of the roentgen ray. The gastrointestinal barium meal, barium enema, and Graham-Cole gallbladder test are among the oldest and most reliable of radiologic studies. Operative cholangiography, despite its obvious limitations, has also for many years been an important x-ray examination in patients with lesions involving the bile ducts. Intravenous cholecystocholangiography, introduced within the past decade, has proved to be a practical, reliable, and valuable adjunct to conventional cholecystography. Many diseases, however, involving the abdominal viscera, particularly the liver and pancreas, remain notoriously difficult to diagnose despite increasingly sophisticated clinical and laboratory technics. The present and future possibilities of surgical procedures for vascular and organ replacement are greatly influenced by the ability to provide precise preoperative documentation of pathologic anatomy. While standard radiographic methods of diagnosis have made significant contributions to the successful treatment of numerous abdominal diseases, a new approach to the investigation of the various abdominal organ systems seems imperative if there is to be continued progress in this field. The purpose of this presentation is to relate a clinical experience with new radiographic technics for examining the abdominal viscera. The discussion covers visualization of the hepatobiliary system in the jaundiced patient and the use of selective vascular injection technics in the investigation of patients with perplexing problems involving the abdominal organs. The current status of these technics will be evaluated and their future potential appraised. The Bile Ducts Patients with jaundice frequently present a difficult diagnostic problem. All too often the commonly employed methods of diagnosis fail to identify the cause of the jaundice. In such situations we have found that percutaneous transhepatic cholangiography permits differentiation between extrahepatic or obstructive and intrahepatic or parenchymal jaundice (1–4). The preoperative percutaneous cholangiograms have proved to be much more informative than operative cholangiography. They provide accurate anatomic information which allows the surgeon to make a preoperative decision and to proceed directly to a specific plan of treatment. In certain situations, after the diagnosis has been established, it may be desirable to institute biliary decompression for a period of time prior to extensive surgery. This applies particularly to patients with long-standing jaundice in whom the cholangiogram reveals a neoplastic lesion that will require a radical surgical procedure for its removal. Decompression is readily accomplished in such cases by placing an indwelling catheter in one of the intrahepatic bile ducts.